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Sleep of 1- and 2-year-old children in intensive care
Insights
Critically ill children in the pediatric intensive care unit (PICU) experience significant sleep loss and frequent awakenings. Sleep disturbances can persist even after hospital discharge, impacting recovery.
Area of Science:
- Pediatric critical care medicine
- Sleep science
- Child psychology
Background:
- Sleep disturbance negatively impacts critically ill children's recovery.
- Adult intensive care unit (ICU) settings disrupt sleep, but pediatric ICU (PICU) sleep patterns are less understood.
- Understanding sleep in critically ill children is crucial for improving care and outcomes.
Purpose of the Study:
- To describe sleep-wake patterns in young children (1-2 years) within a PICU.
- To identify environmental stimuli in the PICU affecting sleep and waking states.
- To compare PICU sleep patterns to pre-illness patterns and determine recovery time.
Main Methods:
- An exploratory field study involving 12 children aged 13-35 months.
- Measurement of pre-illness, post-discharge, and 12-hour PICU sleep patterns.
- Assessment of internal (pain) and external (light, noise, caregiver activity) environmental stimuli.
Main Results:
- Children in the PICU showed significant sleep loss, frequent awakenings, and rapid eye movement (REM) sleep deprivation compared to pre-illness patterns.
- PICU environmental factors like light, noise, and caregiver activity were negatively correlated with sleep.
- Pain and benzodiazepine treatment were associated with sleep acquisition, and sleep changes persisted post-discharge.
Conclusions:
- PICU environments severely disrupt sleep patterns in young children.
- Environmental stimuli and medical interventions significantly influence sleep in critically ill children.
- Sleep disturbances persist after discharge, with parental perception lagging behind objective measures of recovery.
Abstract:
Physiologic and psychologic changes associated with sleep disturbance decrease the ability of a critically ill child to adapt to hospitalization and thus hamper recovery. Research demonstrates that intensive care settings interfere with sleep of adults, but little is known about the impact of these settings on children's sleep. An exploratory field study was conducted to describe the sleep-wake patterns of 1- and 2-year-old children in intensive care, identify intensive care environmental stimuli associated with sleep and waking states, compare the intensive care sleep-wake pattern to the pre-illness sleep-wake pattern, and determine the time required for children to return to their pre-illness sleep-wake pattern. Twelve children aged 13 to 35 months composed the sample for the study. Pre-illness and postdischarge sleep patterns, sleep patterns during a 12-hour night in the pediatric intensive care unit (PICU), and external and internal environmental stimuli were measured. Prior to hospitalization, subjects demonstrated sleep similar to that documented in healthy children. Children in the PICU experienced a significant loss of sleep, frequent awakenings, and a virtual rapid eye movement (REM) sleep deprivation. External environmental stimuli of light, noise, and caregiver activity were negatively correlated with sleep state. Pain and treatment with benzodiazepines were associated with sleep acquisition. Sleep changes persisted after discharge from the PICU and the hospital. Total sleep time recovered more rapidly than nighttime awakening. Parents perceived that their child's sleep remained different longer than total sleep time and night awakening values demonstrated.